You might want to fasten your seat belt. This year could be a bumpy ride.
With a new administration in the White House and the fate of the Affordable Care Act in limbo, the beginning of 2017 portends a lot of turbulence for our healthcare IT journey ahead.
Luckily, we have a host of new in-flight technologies to help us with our travels, and the timing couldn’t be better to put them to the test. Precision medicine, artificial intelligence, and telemedicine are right there in front of us and ready to be used. We’ll also need assistance with navigation, better ways of working together, and to stay safe along the way. Data management, interoperability solutions, and security tools can help us face those challenges.
And if you need advice and a little comfort and companionship from a fellow passenger or pilot, look no further. HMT’s industry experts are here to provide their knowledge about what lies ahead for patients and providers alike.
It’s a weird feeling not to know where you’re going, but we can handle a change in plans. We’ve certainly done that before, and we’ll get there one way or another.
Richard Loomis, Chief Medical Officer and VP of Informatics, Practice Fusion
This is the year that healthcare will revitalize its humanity. In 2016, the healthcare industry made a number of meaningful strides in the move to value-based care, culminating in October with CMS releasing the Final Rule for implementing the Quality Payment Program. In 2017, this focus on value-based care through new payment models will begin to shift to the greater value found in restoring the provider-patient relationship. 2017 offers an opportunity for health IT to support this focus, starting with unwinding the complexity of care delivery and the burden of measuring outcomes. Below are three themes we anticipate seeing in this year:
Just as 2016 was an exciting year of transition in healthcare, 2017 will be no different.
Angela Rivera, Vice President, Health Solutions, Computer Task Group (CTG)
Tom Bizzaro, VP of Health Policy and Industry Relations, First Databank
Bruce Johnson, CEO, Global Healthcare Exchange (GHX)
Despite considerable uncertainty over the future of the Affordable Care Act, the need to deliver better quality care at a more affordable cost remains constant. In 2017, healthcare technology should see a continued and heightened focus on data quality and visibility for a variety of purposes, from reducing costly errors in business transactions to understanding what products and therapies deliver the best outcomes for patients. There is a lot of excitement over advances in analytics, but the success of those new technologies depends upon the accuracy and accessibility of data. Further, many organizations recognize there is still significant waste in the system that can be eliminated through increased automation and better data, reducing the need for manual intervention.
We also anticipate the continued mergers, acquisitions, and other organizational alliances by both providers and suppliers seeking economies of scale, the success of which all depends on being able to integrate and share data. Suppliers will continue to focus on consolidating back-office systems so they can devote more resources toward serving an increasingly decentralized customer base as care moves to more non-acute settings.
Finally, after decades of talking about the need for data standards, we see real momentum with the implementation of the U.S. FDA unique device identification (UDI) rule in the United States, and the European Union planning to issue its own version of the rule this year. More than 50% of suppliers we surveyed have or plan to implement GS1 standards within the next two years, and providers will increasingly take advantage of the product identifiers if not to improve their own data quality, then at a minimum to meet upcoming regulatory requirements to capture UDIs for implantable devices.
Paris B. Lovett, M.D, Chief Medical Officer, HospitalIQ
Despite the uncertainty about the future of the Affordable Care Act, the three Es—efficiency, effectiveness, and experience—will remain a priority for the industry. We can expect to see more being done with bundled payments, as well as increased levels of transparency related to both price and quality. Hospitals will still face intense pressure to improve efficiency and the patient experience. This will drive hospitals to look for ways to reduce inpatient care, whether it’s doing more in day clinics or conducting more post-acute care in people’s homes.
Regardless of “repeal” or “replace,” hospitals will have less room for error with bed allocation, so technologies that help automate and align resources, such as staff, operating rooms, and inpatient beds, will be in greater demand.
Michael Sherling, M.D., MBA, Co-Founder and Chief Medical Officer, Modernizing Medicine
As we enter 2017 and continue to see healthcare technology and delivery evolve, it’s important to reflect on progress, hurdles, and what lies ahead. Key areas of focus in recent months and years have been improved access to care and quality; telemedicine is a technology and strategy that has been highly touted for its potential to improve both.
Since its inception, telemedicine has been a hotly debated topic throughout the healthcare space. The potential has always been evident, but the technology, compliance, and financial models have required ongoing refinement to make this remote care delivery model viable. While early models and technologies were clunky, telemedicine is quickly becoming more mainstream and accepted by patients, providers, and payers. Unfortunately, it seems as if telemedicine took a backstage role during 2016. However, it appears that in 2017 it will thrive, in particular with the new language in the 21st Century Cures Act. This groundbreaking legislation mandates4 that by March 2018, Congress is advised which telehealth services are eligible for reimbursement by Medicare and private payers.
Many physicians view telemedicine as an alternative and efficient way to serve patients. It allows them to provide timely treatment, diagnosis, and professional advice for patients when a virtual visit is appropriate. Often, patients are not able to come into the physical doctor’s office for a variety of reasons, including a lack of mobility or geographic separation. In addition, telemedicine creates a convenient way to treat and assist patients that might not require an in-person appointment, such as follow-up for a rash or acne.
While physicians should understand how new technologies may fit into their workflow before adopting them, telemedicine can provide a unique opportunity for physicians to up-level their business and patient care. With smartphones becoming ubiquitous across the general populace, the primary tools already exist to enable this innovative and powerful new care delivery model.
Here are a few telemedicine thoughts that may come into play in 2017 andbeyond:
Technology continues to play an increasingly larger role in improving physician efficiency and patient care. For physicians who have mainly charted on paper or utilized old technology, new systems may be a challenge, but those who do their homework and understand which systems and technologies best fit their practice and patients should thrive.
The healthcare space is moving forward. By the time our predictions come to fruition, it is likely another form of technology will surface. That said, we do see telemedicine as a huge opportunity and one worth further exploration and adoption. It will require a group effort to achieve some of the positive outcomes I’ve outlined, but I do believe that the patients, providers, and vendors are up for the challenge.
John Squire, President and COO, Amazing Charts
The reality of telemedicine today entails patients connecting with their doctor by securely sending text messages, videos, and pictures with their smartphones. These touchpoints are then captured in the provider’s EHR system and integrated into the patient’s chart/record for accuracy.
While this approach may not require a high level of tech, this type of remote care given by providers is still considered telemedicine, and it will become more and more common over the next year—especially in the direct primary care (DPC) market. Typically, DPC providers take a monthly membership fee from patients in exchange for 24/7 care. As such, most DPC doctors offer secure messaging anytime to provide high-level customer service. For example, patients who visit DPC physicians who use Amazing Charts can easily access their provider by using InLight EHR’s Twistle integration that enables HIPAA secure messaging.
In addition to texting, consumers are becoming technologically savvy and using wearables to gauge their health. Telemedicine will further increase as these technologies enable real-time collection of biometric data such as temperature, blood pressure, and pulse. The latest versions of Fitbits, Apple Watches, etc., will continue to empower patients to stay healthy and active.
In 2017, the expansion of reimbursement for non face-to-face services will also fuel the growth of telemedicine. Medicare’s new billing code for chronic care management illustrates that the future of value-based care does not require 15-minute office visits. Instead, the healthcare environment is shifting toward keeping patients out of the office with follow-up phone calls about medications and answering patient questions via text.
Today’s telemedicine does not necessarily mean video conferencing between physicians and patients in remote locations, but the market may eventually evolve to that level of care. This futuristic view of virtual visits has not come to fruition, mainly because patients don’t want to speak with doctors that don’t have a full picture of their health. Until the interoperability issue is fixed, this will likely remain unchanged.
Anil Jain, M.D., FACP, VP and Chief Health Informatics Officer, Value-Based Care, IBM Watson Health
We at Watson Health use the term “augmented intelligence” rather than “artificial intelligence,” given that our AI aids and assists rather than replaces the role of the clinician. Cognitive technologies coupled with traditional data sciences can quickly read and understand clinical and social data and connect relevant pieces of information to identify areas of risk, apply published guidelines, and then make recommendations on how to best manage the care of the specific individual. Ultimately, the care team makes the final determination but is assisted through cognitive technologies to make population health management a bit more person-centric.
Chronic conditions are a perfect use case for cognitive technologies. Appropriately managing chronic conditions is critical if we are to reduce the unnecessary healthcare spend. Managing chronic conditions requires monitoring various markers (vital signs, blood tests, symptoms, etc.) of disease activity to determine whether patients are optimally managed. Cognitive technologies can examine care paths and disease markers and identify the most appropriate treatment options. For example, Watson Health, in partnership with Medtronic, is developing the first generation of an app expected to uncover important patterns and trends in diabetic patients based on retrospective analysis of patients’ insulin, continuous glucose monitors, and nutritional data. Augmented Intelligence from cognitive technologies can also benefit patients with multiple chronic conditions in which various therapies may interact, leading to complications and poor outcomes. The complexity of these patients can often make it difficult to apply specific guidelines, but cognitive insights can help examine the evidence of various condition-specific guidelines and provide evidence-based recommendations.
Finally, AI can help make big data more actionable. Over the last decade, health systems have made considerable investments in EHRs, enterprise business intelligence, and analytics to respond to various internal and external programs to help improve their quality, reduce cost of care, and measure performance across the organization. Many of these efforts have led to enterprise data warehouses or large data marts, with many of them engineered for traditional analytics based on well-described business rules and rigid definitions. However, with cognitive technologies coupled with big data cloud technologies, health systems can have more degrees of freedom on how they define their metrics, include more disparate unstructured data, and have more timely analytics.
Tashfeen Suleman, CEO, and Dr. Jim Lebret, Medical Director of Clinical Analytics, CloudMedx
2017 will bring about the awareness that while EHRs were great data-entry tools, they need to do a lot more as patient volumes, and their complexity, rise. It is putting a lot of pressure on both the health systems as well as individual doctors who are burdened by maintaining high quality in a clinical environment as well as maintaining revenue. Tools such as AI will help alleviate most of these pressures. For example:
Together, these artificial intelligence tools combine to become greater than the sum of their parts. They serve to unlock the data bottleneck in healthcare and can literally help save lives. Ideally, these AI tools will turn the raw data into information that clinicians will find current, digestible, accurate, and actionable.
For example, a patient may report an allergy to penicillin on a questionnaire. With AI tools, the information can automatically be taken up, processed, placed into the right area of the chart, and even surfaced at a specific moment (i.e., if a penicillin script is written). Another example could be where a system can prompt an unnecessary test or a test that has already been done, thereby saving costs and redundancies in the system. These tools will never replace the clinician but will powerfully augment the clinician to deliver the highest level of patient care.
David Delaney, M.D., Chief Medical Officer, SAP HEALTH
In 2017, precision medicine is poised to begin to deliver on its promise. We are reaching an inflection point where drivers will cause sustained acceleration that will ultimately lead to broad transformation of healthcare.
Continued gains in machine learning, in-memory computing, and advanced visualization will power more nuanced precision medicine. This will enable deeper insights at the moment of decision in a democratized fashion across the enterprise.
But real-world challenges have largely related to interoperability rather than sophistication of analysis. There is good news here with continued maturation and adoption of standards such as Fast Healthcare Interoperability Resources (FHIR). Though there will be fits and starts along the way, 2017 will see progress from a “marketing checkbox” adoption of interoperability standards to a deeper embrace. This will be driven by customers leveraging these services in real scenarios and driving more sophisticated implementations. The political and social winds are blowing strongly toward freeing data, and this will motivate vendors to be on the right side of history—and avoid ending up in front of Congress. The road to seamless interchange may be a thousand-mile journey, but we will be well underway in 2017.
In the past, provider interest in precision medicine has been uneven. There will be progress here too. Nearly 20% of payments are now value based, and the trend is accelerating. This reality seems to have penetrated, causing many organizations to begin to skate toward the proverbial puck even though their payer mix of today isn’t forcing immediate action. And, in healthcare, once movement starts, the rest of the market follows quickly along.
2017 is just the beginning. Ever-cheaper sequencing and the explosion of omics data, along with computational power to make sense of it, ensures that we will continue to see accelerating change as healthcare transforms to a data-driven enterprise.
Drew Ivan, Director of Business Technology, Orion Health
With major projects like ICD-10 and Meaningful Use largely behind us and new initiatives like precision medicine in the future, 2017 will be a transitional year. A great deal of technology infrastructure has been laid down, and 2017 will be the year to deal with some of the implications of these technology investments and get started on some of the value-added functions they enable. Over the past eight years, the healthcare industry has invested heavily in an EHR infrastructure, and in 2017 the risks and rewards related to this investment will begin to come to fruition.
Enabling a shift to value-based reimbursement will be one reward. It will be critical to ensure that the rewards associated with value-based reimbursement flow back to the providers who are enabling it through their increased documentation efforts.
Another reward will be the ability to track specific genomic, behavioral, and social data to enable precision medicine and provide better outcomes than ever before.
President Obama’s signature healthcare project, the Precision Medicine Initiative, and Vice President Biden’s closely related Cancer Moonshot project put the focus on precision medicine in 2016. The 21st Century Cures Act continues funding for these programs into 2017 and beyond, so we should expect continued momentum in this area.
While these programs focus on genetic aspects of precision medicine, a new kind of precision medicine is also emerging. Behavioral and social determinants of health are just as specific to an individual and have just as much impact as genetics. These factors also have the advantage of being easier to manage at a lower cost.
Therefore, in 2017, we should expect to see a broadening of the definition of precision medicine. In the past, the term has been synonymous with genetic variations, but going forward, we’ll see a more comprehensive picture of a patient’s status being used to tailor treatments for their unique situation.
David Finn, Health IT Officer, Symantec
2016 taught me a great lesson: predictions and trends don’t amount to much—remember that election thing? What actually happens is what matters.
Being human, we can’t help but prophesize and forecast the future. The way I see it, a lot of what happens in 2017 in healthcare and HIT depends on what becomes of the Affordable Care Act and how the business of healthcare will be incented and paid for. That is prophecy, at this point. We know that changing the business model will change care, reimbursement, and the number of covered lives, impacting the technology needed and how it is used.
Here are some things we do know will happen in 2017, no matter what happens in Washington, D.C.:
Sean Cannone, D.O., CMD, Senior Vice President and Executive Medical Director, Evolution Health
As we move into 2017, we will see a greater need to increase patient engagement, enhance the quality of care, and improve patient outcomes. We have to start by adopting a patient-centered approach.
Three of the most important strategies for advancing outcomes-based care and a patient-centered care model include:
Providers must tailor therapy to patients’ personal preferences, care goals, and life circumstances, so patients take on a more active role in their health and improve their medication adherence. Additionally, we can optimize patient care in a time-sensitive manner by utilizing an interprofessional healthcare team, such as pharmacists for anticoagulation management, medication regimen reviews, and patient education.
We also know that most patients are not intentionally non-adherent. Adherence is a complicated issue with many possible causes that can include financial challenges, adverse events, memory deficits, and poor health literacy—all of which affect patients to varying degrees. Increased access to technology such as smartphone applications and text messages provides unique opportunities for pharmacists and other healthcare providers to monitor and improve patients’ medication adherence. Technology tends to impact patients with logistics- or memory-related issues the greatest. Meanwhile, for those with primarily social or psychosocial barriers, there is a more muted effect. At Evolution Health, we have found that it is most effective to use technology as a supplement to face-to-face or telephonic communication.
The best technological practices for improving medication adherence involve those that have direct patient contact; this can be telephonic in nature. Face-to-face interaction through video conferencing may be more impactful since it maintains the human element of the patient-clinician interaction. However, the most important element is not the mode of communication, but the frequency of patient encounters. Typically, more frequent patient encounters result in improved medication adherence and patient education. To maintain sustainability, we must leverage the services of an interprofessional team. Apps and text messaging can then serve as technological adjuncts, providing helpful reminders and educational information.
Travis Palmquist, VP and General Manager for Senior Living, PointClickCare
Ramon Chen, Healthcare Data Management Expert and Chief Marketing Officer, Reltio